Sexual Addiction

Sexual addiction is a term that refers to any disorder related to sex and love expression that causes distress to the individual and/or causes harm to another person. Many define it as an intimacy disorder that shares many characteristics with other addiction disorders, including:

Building a tolerance

Compulsive engagement in behaviors associated with the disorder

Negative impact on relationships with friends and family

Negative personal consequences related to employability, personal physical and mental health, and more

Most people who struggle with sexual addictions find that they have a difficult time managing their use of porn, limiting engagement in masturbation to an appropriate amount of time and/or place, or engaging in a monogamous committed relationship. According to US News, 5-8 percent of the population is living with a sexual addiction, and an estimated 33 percent of those people are women.

Is Sex Addiction a Real Disorder?

Many question whether or not sex addiction is a disorder to be taken seriously and treated medically, or if it is an excuse for choices that are perceived by the general public as being in poor taste (as in excessive masturbation, use of porn, engaging in sex with strangers, etc.) or emotionally harmful to others (as in extramarital affairs).

There is, however, a great deal of evidence to support the notion of sexual addiction as a real and true disorder that is only healed through professional treatment. Specifically, there are medications to increase impulse control that have been found to be useful in patients struggling with sexual addictions. Additionally, there are a number of studies focused on identifying why and how sexual addiction develops in some populations more frequently than others (e.g., men more often struggle with the disorder than women). There is also a large body of literary and psychiatric work devoted to helping clients and their families better understand the disorder and to helping therapists better serve those living with sexual addiction.

Diagnostic Criteria

The Diagnostic and Statistical Manual of Mental Disorders (DSM) is updated and maintained regularly by the American Psychiatric Association (APA) with the goal of providing a standard by which treatment professionals can diagnose the symptoms they see in patients and also to help standardize the treatments they receive with the goal of ensuring that all connect with the diagnosis, treatment, and support that are appropriate to their needs.

In previous editions of the DSM, sexual addictions were listed and defined. Termed paraphilic disorders, any and all sexual behaviors that were outside of the mainstream were considered to be a treatable disorder. In the latest edition, the DSM-5, paraphilic disorders and their diagnostic criteria have changed considerably:

The experience of stress related to an atypical sexual interest must be present for it to be a disorder. A disorder is also noted when the atypical sexual behavior involves the mental or physical injury of someone else, another person’s death, or sexual interactions with someone who refuses or with someone is not legally able to give consent. Names of disorders were changed to recognize the fact that there is a difference between the behavior and the disorder (e.g., exhibitionism became exhibition disorder).

The eight different types of paraphilic disorders included in the DSM-5 are:

Exhibitionistic disorder

Voyeuristic disorder

Pedophilic disorder

Frotteuristic disorder

Transvestic disorder

Sexual sadism disorder

Sexual masochism disorder

Fetishistic disorder

Hypersexual Disorder

Though not included in the DSM-5 as a sexual disorder, there is ample scientific evidence to support the existence of hypersexual disorder, a condition defined by engaging in a pattern of sexual urges, behaviors, or fantasies that lasts for six months or more that is not caused by any other mental health issue. A hypersexual disorder is also characterized by the engagement in these sexual choices based on negative moods and the attempt to use the sexual behavior to manage, escape, or otherwise change that mood.

It is problematic that it is not listed in the DSM as a diagnosable and treatable disorder, because it means that insurance providers will not pay for medical or psychiatric treatment for that purpose. However, when it is an issue for someone who is also suffering from a substance use disorder, it can be addressed concurrently and be incorporated into relapse prevention treatment, since hypersexual behaviors can trigger drug and alcohol relapse if the two disorders co-occur.

The Stigma of Sexual Addictions

Too often, the stigma stops people who need help from connecting with the treatment they need. Many report internalizing the stigma and feeling ashamed of the behaviors as well as their inability to manage their compulsions. To admit to someone else out loud that they are having this problem can feel overwhelming, but it is an essential first step in recovery. Recognizing that the sexual addiction is in fact a disorder and not a moral issue or a character flaw is critical as well. Over time, learning how to experience true intimacy and make use of healthier coping mechanisms can help to illuminate the underlying issues driving the disorder and facilitate authentic growth and change.

Sexual Addiction vs. Sexual Offenses

It is important to make a distinction between those who engage in sexual behaviors that are outside of the mainstream, those who are living with a sexual addiction, and those who are classified as sexual offenders. They are not all in the same group, and too often, the public view and mainstream media tend to lump them together using terms meant to denote a specific group interchangeably.

Non-mainstream sexual interests do not constitute an addiction or a criminal offense. A person’s sexual identity is neither a disorder nor a criminal act. Interest in any nonheterosexual, specifically-for-procreation sexual practices is also not a disorder, nor is it something that is prosecutable as long as other participants are of consenting age and do in fact consent to taking part.

A sexual addiction, as stated above, is an intimacy disorder, one that is defined by the inability to manage the compulsive engagement in a sex act despite negative consequences. Someone who is living with a sexual addiction will not necessarily be a sex offender. However, about 55 percent of convicted sex offenders are living with a sexual addiction, and an estimated 71 percent of people who molest children are also diagnosed with a sexual addiction. In these cases, where there is a victim rather than a partner and clear harm done to someone else, sex addiction must be managed with incarceration as well as treatment in order to ensure that no one else is harmed.

Self-Medication and Sexual Addictions

Sexual disorders very often co-occur with substance use disorders. Like other addictions related to behavior or “vice,” many who struggle with the disorder struggle with feelings of guilt, shame, depression, anger, and frustration as a result of their inability to manage the behavior despite increasing negative consequences. In an attempt to address those feelings, many turn to drug and alcohol use as a means of self-medication. Unfortunately, because the sexual addiction is an ongoing and progressive disorder, the stresses it causes continue to grow and so too does the use of drugs and alcohol. As a result, it is not uncommon for someone living with a sexual disorder to also struggle with a substance use disorder.

The Role of Drug Use in Sexual Behaviors

In some cases, use of a particular drug plays a primary role in the sexual behavior at the focus of the addiction. That is, a person may begin their sexual addiction process by going to a bar and drinking heavily, and then have sex with an unknown person, masturbate, or otherwise engage in the sexual activity of choice.

Another common example is the use of “poppers,” a stimulant drug, as a means of sexual enhancement. Many who struggle with sexual addiction disorders and a co-occurring drug disorder may use these drugs as a means of heightening the physical aspect of the experience. Similarly, some prefer to use emotional enhancement drugs like ecstasy to more easily make a personal connection through sex.

It is especially important for someone whose drug use is entwined with engagement in sexual behaviors to undergo treatment for both disorders simultaneously since engagement in one behavior will almost always trigger relapse in the other behavior despite treatment.

Treatment for Sexual Addictions

In most cases, treatment for sex addictions kicks off with 30 days of abstinence from all sexual engagement. This break from making use of the “go-to” coping mechanism sets the stage for the client to begin to do the real work of recovery that comes with therapy. Clients who are in a partnership or marriage may begin to address underlying issues through couples counseling with the goal of rebuilding trust in the relationship and strengthening bonds.

In personal therapy and treatment, the goal is to learn how to develop true intimacy with another person, recognizing all they have to offer intellectually and emotionally as well as sexually. It can take time to learn how to actively place sexual connection on the backburner and genuinely engage with others outside of a sexual context, especially when sex is and must be a part of a functional partnership and romantic relationship. It takes time and persistence and, because it is a chronic condition, relapse may be part of the equation, but with ongoing support and continuing care, it is possible to find balance again.

Co-occurring Disorders and Comprehensive Care

If you, or someone you love, are struggling with both a sexual disorder and a substance use disorder, it is important to not only seek immediate treatment but to connect with the right treatment program – one that has the resources to offer intensive treatment for both disorders simultaneously. During sexual abstinence and abstinence from drug and alcohol use, attentions can turn to exploring past experiences both before and during the addiction phase to better understand how and why the issues developed. This occurs while working on forging authentic bonds in relationships and becoming more comfortable with oneself.